TA i missbruksarbete : Transaktionsanalytisk psykoterapi som behandlingsmetod för drogmissbrukare i miljöterapeutisk vård

Sammanfattning: This monograph studies the outcomes of transactional analysis (TA) psychotherapy with addicts of heavy drugs in long time residential treatment (one year or more) at Swedish therapeutic communities (TCs) during the 1990s. Two sets of data were obtained: The primary material concerned results of approximately one year of TA-therapy; the secondary specific TA-therapy results versus total mileau therapy results. The primary material was therapy data for a group of 67 clients at the Vallmotorp Foundation. The clients and 43 therapists used 10 instruments to document all TA-psychotherapy (usually group therapy) received during 20 months (Oct 1990-May 1992), altogether 2 111 sessions. Including non- documented TA-therapy, the total therapy received was estimated at 4 300 sessions, with an average of 64 sessions/client (range 1-168). A follow- up questionnaire (return rate 60%) was administered about two years after the end of therapy. All available information was condensed, and each client (n=67) was rated as much improved (16), improved (25), unchanged (20), deteriorated (3) or much deteriorated (3). Three results were significant: 1) Clients who received more than 80 TA-therapy sessions improved more than clients with less therapy (p<.001); 2) Clients who had more complete therapy processes (with contact-, contract-, clarification-, regressive- and separation stages) improved more than those with incomplete processes (p<.001); 3) Clients with more qualified therapists improved more than clients with less qualified therapists (p<.02). Other factors (sex, age, country of birth, drugs abused, more or less severe growing up conditions - only two clients had good growing up conditions) were unrelated to outcome. The secondary material (collected 1992-98) was taped interview data, questionnaire answers and taped discussions from 38 clients and 43 staff members at three TCs (Korsaröd, Kolleberga and Punkten) with structures similar to Vallmotorp's. The tapes were partly transcribed, and phenomenographic content analyses were made to identify about 40 different perceived treatment ingredients. TA psychotherapy was identified as a central treatment factor. The findings were discussed in a theoretical context of self psychology, humanistic/existential psycholgy, developmental psychology and, mainly, transactional analysis and Tomkins' human being theory. It was concluded that 1-2 years of qualified TC treatment, with TA psychotherapy focusing on affective training and cognitive script reorientation, is effective in developing a drug addict's capacity to live in interpersonal relationships that are satisfying enough to make drug abuse redundant.